Current Shareware 1994 January/SHAR194.ISO/textfile/amn30621.zip/AMN30621.MN

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ABLEnews MedNotes

                        AMERICAN MEDICAL NEWS (6/21/93)

Playing the Managed Care Game (1):

On the Offense:
State Medical Societies Want Doctors to Captain Provider Teams
  "Many physicians on New York's Staten Island are spreading
  themselves pretty thin these days. But they say they see no other
  defense against the march of managed care...Proctologist Zoltan
  Brody, DO, for example, is on the staff of three area hospitals and
  is seeking privileges at three more. He says he's lost 25% of his
  patients to managed care plans over the past two years and must
  expand his affiliations to survive. Even so, he says the HMOs with
  which he is linked up force him to accept continually deeper fee
  cuts or face being shut out of their panels."

On the Defensive:
Medicine Fights Moves By Blues Plans to Squeeze Physicians
  "Blue Cross and Blue Shield plans, the last bastions of open
  physician and hospital participation, are starting to slam their
  doors in the faces of the groups that created them. Physicians are
  panicking because they no longer have guaranteed access to Blues
  subscribers, who number 67 million nationally and form the bulk of
  many patient bases. Blues plans in Washington state, New Jersey, and
  the District of Columbia are creating sharply limited preferred-
  provider networks. Plans in California and Hawaii are plotting
  similar moves. This has brought angry challenges from organized
  medicine, which feels betrayed by its longtime allies."

Enterprise Liability Backers Stand Firm (1)
  In a letter to First Lady Hillary Rodham Clinton, the AMA and
  specialty and state medical societies decry enterprise liability as
  an untested theory that "will not correct fundamental deficiencies
  in the tort system." At its annual meeting, the Physician Insurance
  Association of America (PIAA) announce their opposition to
  enterprise liability. "But physicians and insurers who oppose the
  idea are standing in front of a speeding train, White House reform
  task force members told the PIAA meeting." CURE Comment: We warned
  you that the covert Clinton health plan sounds more and more like a
  railroad. Let's hope a few more citizens have the guts to stand on
  the tracks so that we can at least get some idea of where the social
  engineers plan to take us for a ride.

Flagging Adverse Events (2)
  "Adverse events are real, they happen, and they threaten the well-
  being of all of us. What this program is about is preventing illness
  and death." --David Kessler, MD, Food and Drug Administration (FDA)
  Commissioner, announcing the FDA's MedWatch program to facilitate
  the reporting of adverse events associated with drugs and medical
  devices.

Disabled Win One on Insurance (2)
  The Equal Employment Opportunity Commission (EEOC) releases an ADA
  enforcement policy stipulating that employees with disabilities must
  have equal access to coverage in all self-insured health plans.

NJ ERISA Ruling Reversed (2)
  A federal appeals court overturns last year's ruling that the
  imposition of a 19% surcharge on hospital bills to pay for
  uncompensated care violates the Employee Retirement Income Security
  Act (ERISA).

NY to Pay Premiums (2)
  Some 750 doctors who agree to treat poor pregnant women and infants
  will have part of their professional-liability premiums paid for by
  the state.

'Reasonable Cost' Is Up to HHS (2)
  in Medicare US Supreme Court rules.

Group Blasts Contributions (2)
  Citizen Action lobbyists lambaste more than $150 million dollars in
  congressional campaign contributions from health and insurance
  lobbies in last 14 years.

More Women Are Salaried (2)
  physicians than men, a University of Michigan study finds.

HCFA Chief Drops Medicare Carrier (3)
  In one of his first official acts as administrator of the Health
  Care Financing Administration (HCFA), Bruce Vladeck dumps King
  County Medical Blue Shield as Washington state's Medicare Part B
  carrier (in favor of Aetna Life Insurance). The move is seen as a
  harsh warning to other carriers to clean up their acts. The
  following are on probation: Blue Cross and Blue Shield of Maryland,
  Empire Blue Cross and Blue Shield (NY), Seguros de Salud de Puerto
  Rico, Blue Cross and Blue Shield of Montana, Group Health, Inc.
  (NY), Blue Cross and Blue Shield of Kansas City, Blue Cross and Blue
  Shield of Utah, and Rocky Mountain Hospital and Medical Services.

High Medicare Outpatient Costs May Spur Rules (3)
  "The shift to outpatient care has revolutionized the way that Lee
  Hartman, MD, practices medicine. Ten years ago, more than 90% of the
  ear, nose, and throat surgical procedures performed by Dr. Hartman
  required inpatient stays. Today he handles all but 5% of those
  procedures in an outpatient setting."  CURE Comment: This is, of
  course, a tautology. "The shift to outpatient care" causes more
  outpatient care, i.e., "revolutionizes" the practice of medicine.
  Actually, as Dr. Hartman subsequently confides, "Economic forces are
  the true driver behind this radical new approach to medicine."

A Meeting of Alternative, Allopathic Minds? (3)
  "Critics and proponents say the term 'alternative medicine' may be a
  misnomer. Here's why: Many proponents favor an integrated approach,
  combining nontraditional therapies with established Western
  medicine. They say the term 'alternative' implies their treatment
  should be used instead of traditional medicine. Critics say
  'alternative' confers equal value to scientifically documented
  therapies and those supported by anecdotal evidence. The term
  'unscientific' is more appropriate, they say."

Blues Plans Gird for Competition Onslaught with Mergers (4)
  "The intended merger of the Blues plans in Illinois, Iowa, and South
  Dakota looks like another move by the Blues to form the kind of
  regional networks most expect to see after health reform becomes
  reality...As recently as 18 years ago, 128 Blues plans dotted the
  insurance landscape. By 1983, that figure had dropped to 97; by
  1990, to 73. The number is now 71 and falling."

Researchers Debate Timing of AZT Treatment (4)
  "Despite new data suggesting early AZT therapy may have no benefit
  over later treatment, two top US researchers [Robert Walker, MD, of
  the National Institute of Allergy and Infectious Diseases, and Paul
  Volberding, MD, director of the AIDS program at San Francisco
  General Hospital] say it may be preferable to start treatment even
  earlier than previously suggested."

Medical Society Fighting Broad Use of Licensing Fees (5)
  "It's not unusual for states to use professional licensing fees to
  fund schools, roads, Medicaid, and other activities unrelated to
  regulating and disciplining doctors. But a lawsuit seeking to block
  such action is. In its suit filed last month against state
  officials, the California Medical Association said the state's
  recent transfer of [medical] board funds constitutes a 'special
  double tax on physicians' and violates state and federal law. The US
  Constitution, the CMA notes, requires states to apply taxes and
  penalties equally."

Where Faith Meets Science (9)
  As the NIH Office of Alternative Medicine gears up, physicians will
  hear more about: acupuncture, ayurvedic medicine, chelation therapy,
  chiropractic, homeopathy, and naturopathy. "It's elevated overall
  awareness just by making it known that the government is aware if
  us. It's an honorable start." --Tori Hudson, ND, dean, National
  College of Naturopathic Medicine, Portland, OR. "There's no question
  in my mind that no matter what takes place [in research], this
  office will do more harm than good. It's turned loose an army of
  people who can now say they're 'affiliated' with NIH." --Stephen
  Barrett, MD, publisher, Nutrition Forum.

Measles Danger Down, Risks Remain for Epidemics (11)
  and other Public Health Updates.

Doctors Urged to Recognize Warning Signs of 'Brain Attack' (11)
  "The symptoms of stroke should have the same alarming significance
  in identifying a 'brain attack' that acute chest pain has in
  identifying a 'heart attack.'"  --guidelines, National Stroke
  Association.

Need for a Two-Person Balance Between Home, Work (12)
  "'My wife doesn't understand me,' my companion said. It was almost
  midnight on a Saturday night but this was no bar, and the man's
  lament was no pick-up line. By the day, Mark Wilcox and I were
  residents in an internal medicine training program. This night, we
  were moonlighting at a community hospital's emergency department." -
  -Linda Fisher, MD, chief medical officer, St. Louis County, MO.

Honoring a Vanishing Breed--the Country Doctor (13)
  "In 1951, when Josephine Newell, MD, hung up her shingle in Bailey,
  NC (population 997), she charged $2 a visit--not much, even in a
  rural community. Her first day, the general practitioner saw 24
  patients. All were men, and none were sick. They just wanted to
  check out the woman doctor, a rarity in those parts at that
  time...Country doctors like dr. Newell are a vanishing breed...Only
  1.5% of medical-school graduates choose to practice in rural
  settings, according to the Association of American Medical
  Colleges."

AMA, Surgeon General Try Once More Against 'Old Joe' (14)
  "At a time when we are attempting to reform our health system and
  improve the health of our citizens, the tobacco industry is
  attempting to enslave a new generation of cancer and emphysema
  victims--our children." -- John Clowe, MD, president, AMA.

Do Kids Want to Smoke Like Joe? (14)
  "Most young children easily recognize the suave cartoon character
  Old Joe Camel, but a study found that doesn't make them want to
  smoke." Editor's Note: The study, authored by Richard Mizerski, a
  marketing professor at Florida State University, was funded by the
  RJ Reynolds Tobacco Company.

Helping Patients Understand Reform (editorial) (15)
  "American Medical News is a newspaper for physicians. This week,
  though we have something for your patients to look at...a special
  insert prepared by the American Medical Association...The questions
  are not intended to encourage patients to attack the Clinton plan...
  but to spur them to take a critical look at it. In that way it can
  be understood--and supported or opposed--based on what it actually
  promises to deliver and not on the campaign-style rhetoric that will
  be used to sell it." CURE Comment: Better yet judge any plan on what
  it is likely to deliver.

Tax--or Penalty? (letter-editor) (15)
  "A provider tax on physicians and hospitals may well be part of
  Clinton's plan to pay for reform (AMNews, May 3). A tax on me
  because I'm a doctor offends my basic sense of justice...it's like a
  penalty for...what? Using the system to make my living?" --Mark
  Moskowitz, MD, Naples, FL.

Cadaver Shortage Dictates Animal Use (letter-editor) (15)
  "Randall E. Ellis recommend using cadavers instead of dogs in
  Advanced Trauma Life Support [ATLS] courses, because it is more
  'humane'... (Letters, May 3)...Dr. Ellis seems blissfully unaware
  that there is an acute shortage of cadavers...Besides, for the cost
  of one cadaver, one can buy 10 dogs, or if he is a dog lover, then
  goats." --Narayan Deshmukh, MD, ATLS instructor, Sayre, PA.

Discouraged by Medicaid (letter-editor) (15)
  "What is discouraging to me is the lack of any respect by Medicaid
  for me or any doctor seeing their patients. The time and effort to
  collect what is promised is not worth the effort, and I'm
  considering leaving the program because of it." --Lloyd Comstock,
  MD, Pittsburgh, PA.

Dr. Huet-Vaughn Displayed Courage (letter-editor) (16)
  "I have followed Dr. Huet-Vaughn's dilemma carefully as the Gulf War
  unfolded...I have the deepest respect and admiration for someone who
  is willing to pay such a devastating price to live up to her
  convictions. Drs. McMillan and Engel (Letters, May 3) should visit
  the Holocaust Museum or read the history of My Lai to get a grip on
  what happens when 'integral members of a team' can demand loyalty to
  all causes." --Jerry Earrl, MD, retired colonel, US Army Medical
  Corps, Potomac, MD.

She Showed Lack of Responsibility (letter-editor) (16)
  "On August 19, 1990, I watched my wife (six weeks pregnant), and 6-
  month-old daughter drive away and wondered if I would ever see them
  again...Five months later I was returned home on emergency leave to
  bury my 11-day-old son and then rapidly return to a war zone just
  prior to the land invasion of Iraq...I am appalled that Dr. Huet-
  Vaughn should feel the right to be pardoned. She has exhibited the
  singular lack of an extremely important part of being a physician--
  responsibility." --Lt. Cmdr. Charles Stone, MD, staff surgeon, Naval
  Hospital Camp Lejeune, Camp Lejeune, NC.

When Health Care Gets Down to the Hard Choices (op ed) (17)
  "Once it is given a mandate, the federal government will design an
  equitable scheme to distribute the resources available for health
  care. Those democratically derived bureaucratic solutions will
  initially seem reasonable. Eventually, they will appear unfair,
  rigid, and unethical in individual circumstances, in which suffering
  human beings request but are denied treatments that society says it
  cannot afford. And doctors, who solemnly pledge to treat anyone who
  seeks their care, will confront the dilemma of failing to uphold the
  oath they have taken." --Robert Kaiser, MD.

There Are No Short-Term Health Fixes in Third World (op ed) (18)
  "Unfortunately, in medical programs during the Vietnam era emphasis
  was often placed upon 'production criteria' during precipitous
  Zorro-type visits of military medical units to isolated areas.
  Numbers of patients seen, animals vaccinated, teeth extracted, etc.
  were deemed most important, rather than the achievement of a
  durable, long-term improvement in the health of the target
  population...30,000 people die every day of the effects of dirty
  water and inadequate sanitation in the underdeveloped world. At
  least 27 million children die each year from...acute lung and
  circulatory diseases, low birth weight, and diarrhea." --Captain
  Arthur Smith, MD, Medical Corps, US Navy Reserve.

Funding Growth (19)
  "To stay competitive in markets demanding increasingly sophisticated
  outpatient services, physician groups are now building ambulatory
  care centers, buying pricey diagnostic equipment, and acquiring
  other medical practices and groups. Some are even buying hospitals.
  That requires money and lots of it."

WHO Tries New Smoking Tactic (21)
  "No doctor should ignore the fact that smoking kills nearly 3
  million people each year and that figure will grow if nothing is
  done." --World Health Organization (WHO).

[The above listing, prepared for ABLEnews by CURE, includes all major
articles in the cited issue and a representative selection of the
rest.]

...For further information, contact CURE, 812 Stephen Street, Berkeley
Springs, West Virginia 25411 (304-258-LIFE/258-5433).